Finance Customer Billing Validation Form

Thank you for taking a few minutes to complete the Department of
Finance Customer Billing Validation Form. The information completed
below will be used to for all future billing and related correspondence
with Fairfax County. Required fields are denoted with red asterisk
* .

1. Enter the customer number and customer name as it appears on
the original correspondence sent from Fairfax County Department of
Finance

* Customer
Number: (12 digit number located on first line of
address block)

* Customer Name:

* 2. Update Customer Name or Check
Box

Updated Customer Name:

No Update Necessary

3. Billing Address (enter full mailing address)

* Address 1:

Address 2:

Suite/Room Number:

* City:

* State:

* Zip code:
+ 4: (optional)

4. Contact Information

* Contact Name:

* Telephone Number: xxx-xxx-xxxx include area code

E-mail Address:

* 5. Please indicate which method
Fairfax County should send any future invoices and related
information. Only one option can be selected

Via US Mail (to US postal
address above)

Via Email (to email address listed below).
You will be sent an auto reply E-mail.